title: Clinical outcomes in children with Henoch-Schönlein purpura nephritis grade IIIa or IIIb.
abstract: Henoch-Schönlein purpura (HSP) is one of the most common causes of systemic vasculitis in children. The incidence of HSP nephritis (HSPN) among HSP patients has been reported to be 15-62%. Even so, what constitutes severe HSPN is controversial. In the study reported here, we retrospectively reviewed the clinical features and prognosis of 101 children with HSPN, ISKDC grade IIIa/IIIb, from January 1992 to November 2008. Patients with isolated hematuria and/or proteinuria <50 mg/kg/day received triptolide alone, and those with nephrotic range proteinuria received a combination therapy of prednisone and triptolide. Nephrotic syndrome was the most common clinical manifestation (45.5%). There were no significant differences in the clinical features (χ(2) = 2.756, P = 0.252), the side effects related to treatment (χ(2) = 2.259, P = 0.894), prognosis between IIIa and IIIb (χ(2) = 3.013, P = 0.222), or prognosis in grade IIIa patients receiving triptolide alone or triptolide and prednisone (χ(2) = 1.207, P = 0.272) and grade IIIb patients (χ(2) = 1.158, P = 0.282). No significant difference in clinical manifestations and long-term prognosis of our HSPN patients with grade IIIa or grade IIIb were found, implying that our patients with International Study and Kidney Disease in Children (ISKDC) grade IIIb were not the most severe cases of HSPN. Our results may also suggest that treatment with steroid may not alter the clinical outcome of such grade IIIa or IIIb patients.
authors.affiliation: Department of Nephrology, The Children's Hospital, Zhejiang University School of Medicine, Hangzhou 310006, Zhejiang Province, China.
authors.forename: Yonghui
authors.initials: Y
authors.lastname: Xia
authors.forename: Jianhua
authors.initials: J
authors.lastname: Mao
authors.forename: Yifang
authors.initials: Y
authors.lastname: Chen
authors.forename: Dayan
authors.initials: D
authors.lastname: Wang
authors.forename: Lu
authors.initials: L
authors.lastname: Cao
authors.forename: Shenhua
authors.initials: S
authors.lastname: Yao
authors.forename: Haidong
authors.initials: H
authors.lastname: Fu
authors.forename: Lizhong
authors.initials: L
authors.lastname: Du
authors.forename: Ai'min
authors.initials: A
authors.lastname: Liu
mesh_terms: D000293:Adolescent; D001706:Biopsy; D016009:Chi-Square Distribution; D002648:Child; D002675:Child, Preschool; D002681:China; D004224:Diterpenes / Q000009:adverse effects / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D004852:Epoxy Compounds / Q000009:adverse effects / Q000627:therapeutic use; D005260:Female; D006417:Hematuria / Q000188:drug therapy / Q000209:etiology; D006801:Humans; D011695:IgA Vasculitis / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D007166:Immunosuppressive Agents / Q000009:adverse effects / Q000627:therapeutic use*; D008297:Male; D009393:Nephritis / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology; D009404:Nephrotic Syndrome / Q000188:drug therapy / Q000209:etiology; D010616:Phenanthrenes / Q000009:adverse effects / Q000627:therapeutic use*; D011241:Prednisone / Q000009:adverse effects / Q000627:therapeutic use*; D011507:Proteinuria / Q000188:drug therapy / Q000209:etiology; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D004224:Diterpenes; D004852:Epoxy Compounds; D007166:Immunosuppressive Agents; D010616:Phenanthrenes; C001899:triptolide; D011241:Prednisone